The present invention relates to a method for spreading skin grafts and to spreading means, a stretcher and a membrane to be used therewith, as well as to a method for applying skin grafts to a burn.
In practice a method for spreading skin grafts often comprises placing skin grafts on gauze which has been pre-folded in two directions in advance (pleat). To that end an adhesive is applied to the skin grafts on the pre-folded gauze, and after the adhesive has dried the folded gauze is stretched in two directions, as a result of which the distance between the skin grafts is increased. This has led to the situation wherein the small squares, viz. the cut skin grafts, are arranged in regularly spaced-apart (about 5 mm) relationship, with the cutting side facing upwards. Then the folded bandage is laid loosely on the excided area, provided with perforations for drainage, and subsequently fixed in position by means of gauze. In this manner an increase in area of about nine times the original dimension is obtained. The drawback of such a method is that after about one week the gauze is removed under an anaesthetic and can be replaced by donor skin. Another drawback is the fact that it takes a considerable amount of routine to be able to carry out such a method. In addition to that the use of an adhesive is undesirable, because it has an adverse effect on the production of large amounts of skin grafts.
In addition to that it is known from International patent application WO 92/15251 to stretch skin, using stretching means to be fitted to a patient under local anaesthesia. The extra skin which is formed by said stretching in conjunction with the natural growing power of the human skin is cut away and used for transplantation purposes. A drawback of such a method is the fact that it takes surgery to obtain additional skin.
Now a method for spreading skin grafts has been found which does not exhibit the above drawbacks. In addition to that the method which has been discovered can be carried out by medical staff who have not been specially trained for this purpose.
The method as referred to in the introduction is characterized in that the skin grafts are placed on an elastic membrane, after which the membrane is stretched in at least two directions substantially perpendicular to each other and the skin grafts present on the membrane are spread.
A method for forming skin grafts is known from Dutch patent application No. 1004276, which document may be considered to be incorporated herein. Although it is possible to use any other known method for forming skin grafts, such as the method known from International patent application WO 84/02464, it is preferred to use the method according to Dutch patent application No. 1004276.
It is preferred to use as a membrane a carrier which is used for forming the skin grafts. According to this method an increase in area of about nine times the original dimension is achieved. From practice it has become apparent that in this manner little auto transplant or autogenous skin is needed to cover large defects on burn patients.
The present invention furthermore relates to spreading means to be used for increasing the distance between the skin grafts, which means is characterized in that said spreading means comprises an elastic membrane which is connected to arms which are capable of movement in at least two directions in the same plane, which arms are made of a material which is less elastic than the material of which the membrane is made, as well as a base member, which can be connected to said arms.
In a preferred embodiment said spreading means comprises four to eight arms which are capable of movement in opposite directions in the same plane, which arms can be connected to the base member, after which the arms are extended. Since the material of which the membrane is made is more elastic than the material of which the arms are made, the surface area of the membrane will be considerably extended as a result of the extension of the arms. Thus the distance between the skin grafts will be increased and the spreading of the skin grafts has been achieved.
In a special embodiment of the present invention the skin grafts formed from skin, which adhere to a carrier, are transferred to the elastic membrane of the spreading means by transport means operating at a sub-atmospheric or reduced pressure. A transport means operating at a sub-atmospheric pressure is known from International patent application WO 84/02464. The skin grafts adhering to the transport means are removed therefrom by releasing the sub-atmospheric pressure, possibly in conjunction with the moving of pins from an ejector through the apertures of the transport means, or by applying a slight overpressure by using compressed air, after which the skin grafts land on the membrane, in particular on the central part thereof. Then the elastic membrane is stretched by moving the arms of the assembly of membrane and arms, which is according to the present invention preferably carried out by using wind-up means connected to the base member, which wind-up means are rotatably mounted therein. Such wind-up means can be connected to the arms, as a result of which the membrane connected to the arms can be stretched and the skin grafts present on the membrane can be spread. The assembly of membrane and arms is preferably moved by connecting the arms to the base member via wind-up rods, which wind-up rods can be moved by means of a ratchet wrench and a gear wheel, for example. Further extension of the membrane by means of such wind-up rods, whereby the arms are wound on the wind-up rods, will result in the distance between the skin grafts being increased. In certain embodiments of the present invention the arms may already be attached to the base member, however, and the membrane may have to be connected to the arms so as to spread the skin grafts present on the membrane. The advantage of this is that the membrane can be disposed of after use and be replaced by a new membrane. If the membrane and the arms are made in one piece, the arms must be connected to the wind-up rods, and the assembly of membrane and arms can be removed and be replaced after use.
It is preferred to make the membrane of an elastic material having a rough surface or porous material in order to ensure a minimal adherence of the skin grafts to the membrane. A woven or knit material is suitable as the porous material for the membrane. The advantage of a material of this type is that when a force is exerted thereon, the yarns are pulled apart, as a result of which the desired space between the yarns, or the desired porosity, is achieved. In addition to that it must be possible to subject the membrane to a sterilization treatment. In a special embodiment of the spreading means the space under the membrane is provided with a connection for sub-atmospheric pressure and compressed air. Preferably also an ejector is mounted in such a space. It should be apparent that spread skin grafts can be removed from the spreading means by tweezers, but this is very time-consuming, and in practice it is preferred to use the transport means described in Dutch patent application No. 1004276.
In a special embodiment of the spreading means according to the present invention a stretcher is provided, which can be connected to the base member. The arms of the elastic membrane can be clamped down in such a stretcher, thus making it possible to maintain the stretched condition of the arms, which is obtained by stretching the arms, using the above-described wind-up means. Thus the stretcher with the spread skin grafts present on the membrane can be detached from the base member and be transported to the intended location. The base member will then be available again for spreading a new batch of skin grafts in accordance with the method of the present invention. The advantage of using such a stretcher is that large amounts of spread skin grafts can be obtained at short intervals, in particular by using only one base member.
In a preferred embodiment of the present invention the stretcher to be used in spreading skin grafts comprises at least two clamping means, in which the membrane and/or the arms connected to the membrane can be clamped down. More in particular the number of arms connected to the membrane corresponds with the number of clamping means present in the stretcher, preferably the number of clamping means is four to eight. The clamping means according to the present invention preferably comprises a base member and a top member, whereby said base member and said top member exhibit a clamping action.
The present invention furthermore relates to a method for applying skin grafts to a burn, which method is characterized in that a skin-like material is placed on the spread skin grafts, after which the skin grafts adhering to said material are applied to the burn. Preferably a gauze of plastic material is used as a suitable skin-like material. More in particular donor skin is used. When the skin grafts are covered with donor skin, the healing process is accelerated, which is desirable in practice.
In another embodiment an adhesive is first applied to the spread skin grafts, after which a skin-like material is placed on the skin grafts provided with an adhesive, and the whole is subsequently applied to the burn. The advantage of applying an adhesive is that the spread skin grafts adhere to the material in an advantageous manner, as a result of which no skin grafts are lost.